This application is related to U.S. provisional application 60/711,279, filed Aug. 25, 2005, and U.S. utility application Ser. No. 11/316,775, filed Dec. 23, 2005, each of which is incorporated herein by reference. During angiography and related procedures, catheters are inserted through an incision or puncture in the skin and underlying tissues to access an artery or vein, typically in the groin, neck, or subclavian areas of a patient. The catheter can be inserted through a puncture in the blood vessel and guided to the desired site to perform interventional procedures such as angiography, angioplasty, plaque removal, and infusion of a therapeutic substance. After the procedure is completed and the catheter is removed from the patient, the access hole must be closed to prevent massive hemorrhage. This is conventionally achieved by applying pressure over the blood vessel manually and then by applying a pressure bandage, compressive weight, or clamp device. With conventional methods, the rate of post-puncture hemorrhage is high, which causes considerable complications. This complication is exacerbated by the concomitant use of anticoagulant medications such as heparin or warfarin and by antiplatelet drugs, which are commonly used to treat vascular disease.
Sutures have been used to close access puncture wounds in blood vessels. For example, U.S. Pat. No. 5,613,974 describes a device and method for applying sutures to a vascular puncture, U.S. Pat. Pub. 2004/0093027A1 describes barbed suture-like material that apposes the puncture site, while U.S. Pat. Pub. 2005/0121042 A1 describes a device and method for applying suture to a vascular puncture. Difficulties with these methods include the large number of steps necessary to deploy the needles, capture the suture, withdraw the suture, tie the knot, and cut the suture. In addition, the hole in the blood vessel is often widened by insertion of the instrument, and the suture remains intravascularly on the endothelial surface, and thus can be a nidus for thrombus or intravascular mural hyperplasia with later spontaneous and catastrophic closure of the vessel.
Extravascular plugs have also been proposed for closure of vascular punctures. For example, U.S. Pat. Nos. 5,254,105 and 5,330,445 describe an extravascular plug which is slid down the external surface of the catheter or introducer and is placed into the puncture site in this manner. U.S. Pat. No. 5,643,318 relates to a similar device that has its own vessel locator device, while U.S. Pat. Pubs. 20020022822A1 and 2004/0158287A1 describe an extravascular plug that is delivered with a specialized system, U.S. Pat. Pub. 20040215232A1 describes an extravascular plug with an intravascular anchor set with a sheath with a detection port, and U.S. Pat. Pub. 2005/0085855A1 describes an extravascular collagen plug, held in place with an intravascular anchor, and a device that locks over a piece of suture. Other extravascular plugs are described in U.S. Pat. No. 5,906,631, which describes a plug made of hydrophilic material, U.S. Pat. No. 6,126,675 which describes an intravascular anchor and a bioabsorble extravascular plug, U.S. Pat. No. 6,623,509 which describes a bioabsorbable plug, U.S. Pat. No. 6,569,185 which describes an injectable vascular plug, and U.S. Pat. No. 6,663,655 which describes a plug that screws in the puncture tract. U.S. Pat. Nos. 6,296,657 and 6,743,195 describe an inflatable balloon that puts pressure on the puncture site, while U.S. Pat. Pub. 2004/0143290 A1 describes a combination of an intraluminal balloon and injectable sealant. Disadvantages to these methods are related to the high likelihood of thrombosis associated with the intravascular plug or anchor, and the presence of collagen or other bioabsorble materials which cause inflammation, activate the clotting cascade, and increase the likelihood of thrombosis, which, in an arterial system, is catastrophic.
Vascular patches have also been used for repairing blood vessels, but usually only for large areas of damage. For example, U.S. Pat. No. 5,100,422 describes a vascular patch that is sutured to the external surface of the damaged blood vessel and U.S. Pat. No. 5,100,422 describes a vascular patch achieved by instilled adhesives and the device for doing such; however, these are generally impractical for catheter-based methods. U.S. Pat. Nos. 6,248,124 and 5,507,744 describe devices and methods that use electrocautery for sealing vascular punctures, but this also requires a complicated device, and perforation and thrombosis are very real possibilities.
Vascular clips or staples delivered through a catheter device have also been proposed. These devices have penetrating members that bring the edges of the tissue together. For example, U.S. Pat. No. 6,695,867 describes a clip or staple that is delivered by a specialized device, U.S. Pat. No. 6,749,622 describes a number of different clips with sharpened barbs or ends that include both intra- and extravascular portions, made of metal with memory characteristics, U.S. Pat. No. 5,861,005 describes an arterial staple that is delivered with a specialized device, U.S. Pat. Nos. 6,296,657, 6,663,655, and 6,749,621 describe a clip that is external to the vessel, but clips the two sides of the puncture together, and a device for achieving such, while U.S. Pat. Nos. 5,782,861 and 5,964,782 describe clip devices composed of two or more prongs or hooks that, depending on the direction of the prongs, can clip together the puncture site from the intra- or extravascular position, through the use of a collar which forces the prongs together or other mechanisms. U.S. Pat. No. 5,919,207 describes a stapling system based on long hooked wires that appose the surfaces, with a small staple gun to close the lesion, while U.S. Pat. No. 6,022,372 describes a similar staple gun. These clip devices are composed of thick semi-rigid material, and can be placed only with a specialized instruments, and because of the rigidity have great potential to injure or cut the blood vessel. Disadvantages of these clip devices in general include difficulty in retrieving the device if misplaced, excessive manipulation required, the thickness of the clip material which tends to cut or shear the blood vessel, the large forces that must be used to curve the staples and fix the clips, the increased possibility of tearing the blood vessel, and the general lack of control of the forces being applied to the blood vessel.
Accordingly, there is a need for methods and apparatuses that are suitable for closure of vascular punctures or other openings, and that do not suffer from the drawbacks of conventional approaches.